- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,797.00 / $5,467.00 / $12,237.00
| Facility | | $1,797.00 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.90 / $2,722.10 / $4,532.57
| Facility | | $1,939.90 | $2,722.10 | $4,532.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.74 / $918.58 / $6,239.00
| Facility | | $579.74 | $918.58 | $6,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.00 / $3,275.00 / $6,307.00
| Facility | | $1,833.00 | $3,275.00 | $6,307.00 |